Healthcare Provider Details

I. General information

NPI: 1053275149
Provider Name (Legal Business Name): CHARLES COUNTY HEALTH DEPARTMENT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/12/2025
Last Update Date: 02/20/2026
Certification Date: 02/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4202 INDIAN HEAD HIGHWAY
INDIAN HEAD MD
20640-0000
US

IV. Provider business mailing address

4545 CRAIN HWY
WHITE PLAINS MD
20695-3045
US

V. Phone/Fax

Practice location:
  • Phone: 301-609-6900
  • Fax:
Mailing address:
  • Phone: 301-609-6900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: KAREN WALDBAUER
Title or Position: DEPUTY HEALTH OFFICER
Credential:
Phone: 301-609-6900